No one really wants to be in pain. This is understandable because it is unpleasant. But it does have its purpose and now that we are understanding so much more of what it involves, this allows us to reconsider our beliefs around it.

Pain is complex. However having a basic understanding of the physiological foundation for pain is a great start. Understanding pain physiology will change the way we think about pain, reduce its threat value by empowering us and improve overall management of pain. It’s time we equipped ourselves with more knowledgeable and more efficient tools to tackle this epidemic!

Our misconceptions around pain

Here’s a little questionnaire for you. If you answer yes to more than 3 of these questions, you are part of the majority of people (and myself until a few years ago) who have misconceptions about pain.

When you are in pain, do you think that a health practitioner is going to fix you or cure the pain? Yes/No

Do you think that pain relief is necessary before you can become active again? Yes/No

Do you often take a drug to “take the edge off” the pain? Yes/No

Do you think that increased pain means that you have injured yourself, or made the injury worse? Yes/No

Do you often think that doctors have missed something, or that you need more investigations to explain your pain? Yes/No

Do you think that if an x-ray or MRI/CT scan show an anatomical pathology, then that is what is causing your pain? Yes/No

Purpose of it - Why do we experience pain?

Pain is everywhere. You are not alone. Right now, there are about 20 percent of people on this planet who have pain that has persisted for more than 3 months. Why is it that way?

Let’s talk about the basics for a minute. We classify pain as acute or persistent/chronic pain.

Acute pain: This is the pain when you get a paper cut on your finger, or you just put your finger on the pan that was really hot. Pain is useful in this situation because your brain detects the action as a threat and as a response retrieves the finger from the threat. Once the threat has disappeared, the tissues are left to heal and each tissue has a specific healing rate.

Persistent pain: When pain persists and feels like it is ruining your life, it is hard to see its purpose. But even when pain has been around for years and years, it is still there and nasty because the brain has concluded that there is threat or danger and that you need protecting-the trick is finding out why the brain has come to the conclusion.

Complexity of pain-it is multifactorial

Yes, we are right in the middle of a huge paradigm shift where our clinical knowledge about what’s happening in your tissues is only ONE part of the whole pain experience. In fact, by knowing what is happening physiologically in your tissues, I simply can’t predict how much pain you are experiencing!

But it is the BRAIN and the brain only that decides whether something hurts or not, 100% of the time, with absolutely NO exceptions. He is the boss.

Nerve signals get sent to the brain when a peripheral tissue is injured. The brain then checks with your memory centre, emotional centre, sensory centre, fear conditioning and motor centres and many many more in the brain to only THEN release an output of pain that can be intensified or reduced. Isn’t that amazing?! You have to check in with the boss first before you actually feel the pain.

What can we do about it?

Consult with your osteopath and get an idea of how long it will take for your injured tissues to heal (acute pain) or how long it should take for there to be a change (persistent pain). Manual therapy itself is a tool that sends signals to your brain telling it that it is safe, and not a threat.

Think positively-

‘this pain that I am experiencing is here for a purpose’,

‘my pain might be quite bad for a while, but it doesn’t mean it will be there forever’

‘I am in control, I can find ways to manage this’

‘if this has happened because of an underlying cause eg. posture, I will do something about it to avoid this happening again’

Use relaxation techniques eg. Yoga, mindfulness, meditation are all beneficial for decreasing the neurological sensitisation in the area, that may be increasing your perception of the pain

Move-keep mobile, our bodies are designed to move! Even if you are in a little bit of pain, stay mobile.

Desensitise the central nervous system (the brain, the boss)-this can be done through all of the above

All these strategies help to de-threaten the value of pain. They help you overcome fear of movement and send constant signals back to the brain that it is OK to be in a little bit of pain.

“Everyone can understand the basics around pain science. And it is our role as osteopaths to educate patients about this. It needs to be a team effort between the osteopath and the patient. We need to figure out why the brain is still seeing a healthy tissue as a source of pain, ie beliefs around pain, previous trauma, previous emotional experiences and work on developing management strategies around that”Clementine Carnus, Associate Osteopath at City Osteopaths, Wellington

This picture is of Man Kaur, from India. In April she won the 100m at the World Masters Games in Auckland, 101 years young. The purpose of this article is to educate, promote quality therapy, but most importantly to inspire activity and quality movement.

EducateThere is one aspect of life that all of us will go through which is ageing. Whether we like it or not we will all physically deteriorate with age. But what can we do about it? Sit back and accept fate with declining health, or be proactive in maintaining the strength and mobility we have…'I've got creaky knees, my back is a bit stiff, reaching down to put my shoes on is so hard … it must be old age'. As a practitioner, I've heard them all. It's the age old excuse. Some of these complaints are justified, but many of the clients I have come across in both the gym and massage therapy setting will reluctantly admit they just haven't prioritised being active enough. The old adage 'use it or lose it', remains very true. Strength and joint mobility will decrease with age, they will also deteriorate through lack of use. Moving joints can help to increase synovial fluid to the joint capsule and this will keep the joint moving smoothly. Movement will also help the surrounding soft tissues remain both strong and flexible. This is why we need to feel the urge to stretch when we get out of bed, or standing up from prolonged sitting. The soft tissues in our body adapt to a particular position, the stretching is our body trying to prepare these soft tissues for movement.

Staying mobile and strong is important for more than just being able to tie your shoes and get up the stairs. Being active is linked with decrease chances of mortality. The study by Brito et. al. (2012) assessed 2002 adults aged 51-80 on their ability to move from standing to sitting on the floor and back up to standing again. The people who could stand and sit with ease lived longer. The test can be found here http://journals.sagepub.com/doi/abs/10.1177/2047487312471759This test is not 100% accurate in telling you when you will die. There are many factors involved in how long you shall live. But the theme of being stronger and more mobile leading to living longer is what I and the authors are trying to emphasise. If you can move better, you are more independent, you are also more likely to exercise. This can help decrease cardiac risk factors, as well as help maintain a healthy weight, which will further reduce many mortality factors. There are other factors that will limit your performance in a sit to stand test such as lower limb joint replacement, arthritis, neurological disease, other joint surgeries may also limit your joint range making sitting on the floor difficult. So don't panic if you have co-morbidities that will cause you to score poorly in a test like this.

Promote quality therapy“I'm stiff, sore and don't move with ease, what should I do about it?”. For many people the answer is simply to move more. Move more often, move for leisure, move for exercise, move to break up the monotony of prolonged sitting. If you want some advice on how to move well I have the training and experience to help instruct you. You may require more strength, more mobility, more balance, or a combination of all three. Understanding your weaknesses is the first step to improvement.

Massage therapy can also play a role in improving movement. Massage can help increase range of motion by releasing tightness in muscle and soft tissue, or minimising the referred pain that tight muscles can cause to a joint. The increased movement around the joint will make it easier to train for strength and balance, this will lead to fewer compensations (such as limping).

Articulation (movement) of the joint will help to keep the fluid of the joint healthy and nourished.

​Regular stretching will also help you stay mobile and injury free. Stretching is more effective when designed specific for your needs. If you need help with this, I am more than happy to shed some light on this complicated and sometimes controversial topic.

InspireMovement is important for all ages, the longer you neglect it, the harder it is to get back. Age should not be a barrier for activity, getting out as part of a team may make it more fun. 28,676 people competed in the World Masters games in Sydney in 2009. The age categories go all the way up to 100 and over age group. If Man Kaur can do it at 101, so can you. That is of course if the threat of increased mortality hasn't already got you out of your chair!